6.0 Nunavut Immunization Certification

Contents

6.0 Nunavut Immunization Certification Policy

6.1 Nunavut Immunization Certification Process

6.2 Administration of Non-publicly Funded Vaccine in Nunavut

Appendix A: Nunavut Immunization Skills Checklist

Nunavut Immunization Manual (updated July 2018) Page 1 of 1

Immunization Certification Policy_FINAL_July2018 Page 1 of 4

Department of Health Government of Nunavut

NURSING POLICY, PROCEDURE AND PROTOCOLS Community Health Nursing

TITLE: SECTION: POLICY NUMBER: Nunavut Immunization Certification Nursing Practice 07-005-00

EFFECTIVE DATE: REVIEW DUE: REPLACES NUMBER: NUMBER OF PAGES: July 1, 2018 July 1, 2021 07-005-00 4

APPLIES TO: Registered Nurses, Licensed Practical Nurses, Nurse Practitioners, Midwives

1. BACKGROUND:The goal of the Nunavut Immunization Certification process is to provide an ongoing, standardized education for all healthcare workers involved in the administration of immunizations and TB skin tests. The education modules have been developed in accordance with the Nunavut policies and procedures, the Nunavut Immunization Schedules, the Canadian Immunization Guide (CIG), and the Public Health Agency of Canada (PHAC) immunization competencies.

Although many nurses or midwives might not administer the full array of vaccines as part of their regular practice, they will need the requisite knowledge and skill base to answer questions regarding vaccines and immunization schedules. Additionally, these healthcare professionals should be prepared to assist with any mass immunization clinics in the event of a pandemic, health emergency, or as part of annual influenza activities.

2. POLICY:All immunization providers must be certified to give publicly funded immunizations in Nunavut. This is a transferred health function from the office of the Chief Medical Officer of Health (CMOH). Therefore, all registered nurses, nurse practitioners, licensed practical nurses, and midwives who provide publicly funded immunizations and/or perform tuberculosis skin tests (TSTs) are required to successfully complete the Nunavut immunization certification program. This process must be complete before any unsupervised immunizations or TSTs are given.

Immunization certification consists of the completion of an online exam and an immunization skills checklist. The online exam includes a review of 6 education modules and a 75 question multiple-choice exam. The passing grade for the exam is 80% and exam writers will have 3 chances to successfully achieve a passing grade. A certificate will be emailed to the immunization provider. The immunization skills checklist (Appendix A) was developed as a resource for immunization providers to have an ongoing assessment of their competence in providing immunizations in Nunavut. This checklist should be completed with initial certification, then every 3 years with recertification. This is a shared responsibility of both the immunization provider and their supervisor/manager. The original copies of both the certificate and skills checklist are filed in the immunization provider HR file and copies are provided to the immunization provider.

6.0 Nunavut Immunization Certification Policy

Immunization Certification Policy_FINAL_July2018 Page 2 of 4

Recertification should be completed every 3 years. The recertification process includes completing the immunization skills checklist as well as writing the online exam. The recertification process is the responsibility of both the immunization provider and their supervisor/manager.

3. PRINCIPLES:

The Registered Nurses Association of the Northwest Territories and Nunavut (RNANT/NU) highlights that continuing competence is essential to professional nursing practice and that “competence is continually maintained and acquired through reflective practice, lifelong learning, and integration of learning into nursing practice” (RNANT/NU, 2010).

4. PROTOCOL:Registered Nurses, Licensed Practical Nurses, Nurse Practitioners and Midwives are governedby their respective professional associations and by Government of Nunavut regulations. Thefollowing table outlines the population parameters for each group of certified immunizers.

Profession Population Parameters Registered Nurses May provide immunizations and TSTs (plant and read) to all

populations as per: o Routine and catch-up immunization scheduleso Specific vaccine protocolso Or as directed by the office of the CMOH (e.g. outbreak

situation).Registered Midwives May provide immunizations to infants and women of reproductive

age as per: o Routine and catch-up immunization scheduleso Specific vaccine protocols

Licensed Practical Nurses May provide immunizations to Nunavummiut >5 years of age as per:

o Routine and catch-up immunization scheduleso Specific vaccine protocolso Or as directed by the office of the CMOH (e.g. outbreak

situation).May plant TSTs on Nunavummiut > 5years of age and read TSTs on Nunavummiut of any age.

Nurse Practitioners May order/give vaccines as per professional regulations. May provide immunizations and TSTs (plant and read) to all populations as per:

o Routine and catch-up immunization scheduleso Specific vaccine protocolso Or as directed by the office of the CMOH (e.g. outbreak

situation).

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The following table outlines the specific roles and responsibilities of immunization providers and other supporting staff within the Nunavut Immunization program.

Profession/Title Roles/Responsibilities

Registered Nurse Licensed Practical Nurse Registered Midwife Nurse Practitioner Agency nurse

• Complete initial online education modules and exam.• Complete initial skills checklist and review with

supervisor/manager/agency.• Complete skills checklist every 3 years.• Complete immunization exam every 3 years.

Supervisor/Manager

Agency supervisors

• Ensure that all new staff are oriented to the immunizationpolicy.

• Review initial skills checklist and support learning opportunitiesfor staff. Refer to educators/proficient peer immunizers asneeded.

• Review skills checklist with immunization providers and ensurestaff are current on certification. The skills checklist can also bereviewed by an educator or experienced colleague.

Nurse Educators • Complete initial online education modules and exam.• Complete initial skills checklist and review with

supervisor/manager• Complete skills checklist every 3 years.• Complete immunization exam every 3 years.• Support staff to become proficient in immunization skills.

Regional CDC • Complete immunization certification and remain up to date asper guidelines for registered nurses (as above).

• Available as resource for immunization relatedquestions/concerns.

• Communicate questions/concerns to Territorial CDC/CMOH.Territorial CDC/CMOH • Complete immunization certification and remain up to date as

per guidelines for registered nurses (as above).• Maintain database of certified individuals in Nunavut and report

to CMOH as requested.• Update immunization education modules and exam as evidence-

based practice/vaccine guidelines change.• Address any questions/concerns brought forward by Regional

CDC.• Review policy as outlined.

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5. REFERENCES:

Nunavut Midwifery Profession Practice Regulations (2010). SCHEDULE E- DRUGS AND SUBSTANCES.

Public Health Agency of Canada (2008). Immunization Competencies for Health Professionals. Retrieved from: http://www.phac-aspc.gc.ca/im/pdf/ichp-cips-eng.pdf

Registered Nurses Association of Northwest Territories and Nunavut (2010). Scope of Practice for Registered Nurses. Retrieved from: https://rnantnu.ca/sites/default/files/Scope-of-Practice-for-Registered-Nurses.pdf

Approved By: Date:

Kim Barker, Chief Medical Officer of Health Approved By: Date:

July 20, 2018

Jennifer Berry, Chief Nursing Officer

July 30, 2018

6.1 Nunavut Immunization Certification Process

Step 1 Go to: https://nunavuthealth.skillbuilder.co/sign-in

Step 2: Click on “Create account”

Step 3: Fill in each box marked with a red asterisk (*) and then click on “Create Account”.

Nunavut Immunization Certification Process (July 2018) 1

Step 4: Follow prompts to check your email and confirm your account. You will receive an email from SkillBuilder Notifications [notifications@skillbuilder.co] with the subject heading “Account Created - Verify Account”. If the email is not in your inbox, check your “Junk E-mail” or “Spam” folder. In the email, click on the link: Verify Your Account ***Please note - if you have any issues related to the online platform, you can contact the administrators directly using the help function on website.

Step 5: Clicking on the link above will bring you back to the https://nunavuthealth.skillbuilder.co/sign-in website. Now you can Log in using the Username and Password you created.

Step 6: Once logged in, you will be in the “My Dashboard” portion of the website. Click on the “My Learning Paths” circle:

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Step 7: From there you will see the Immunization Certification Course 2018. Click on the course.

Step 8: Review the course outline for learning objectives on the 6 education modules. There is also a link to the Nunavut Immunization Manual online. You will notice that the icons are in yellow until the item has been completed, when they turn green.

Step 9: Complete the Intake Questionnaire by downloading the document, filling in each field, and then uploading the saved document back to the website. This information will be collected by OAMRS staff and marked as complete once they have received it. Expect for this icon to remain ‘yellow’ until this part has been reviewed. You may still move on with Module 1 and complete the course.

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Step 10: Review each of the 6 learning modules. Once completed, each module will turn from yellow to green. All 6 modules must be green in order for the course to be considered completed.

Step 11: Complete the exam. Once complete, the exam will be automatically scored. Review all incorrect questions which include a rationale for the correct answer. If you are unsuccessful on the exam, please review the course content and try again.

Step 12: Complete the course evaluation online.

Step 13: The course is complete! Download your certificate by clicking on the “Recognition” tab. Keep a copy for your files and provide a copy to your supervisor to be kept in your HR file.

Step 14: Review and complete the Skills Checklist (Appendix A). Keep a copy for your files and provide a copy to your supervisor to be kept in your HR file.

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6.2 Administration of Non-publicly Funded Vaccine in Nunavut Background: In addition to publicly funded vaccines in Nunavut, nurses may be asked to administer non-publicly funded vaccines ordered by nurse practitioners (NPs) and/or physicians. These vaccines could be recommended for specific health conditions, travel, or upon the request of the recipient themselves. These vaccines can be important in providing protection against specific vaccine preventable diseases; Nunavummiut should be able to access and privately pay for the vaccines. Policy: Nurses may administer non-publicly funded vaccines ordered by NPs and physicians, in accordance with the vaccine’s prescribed route, dose, and schedule (for vaccine series). All non-publicly funded vaccines must be purchased privately by the patient from a pharmacy; publicly funded vaccine stock in the health center should not be used. Definition: Nurse – For the purpose of this policy, nurse refers to Registered Nurses and Licensed Practical Nurses. Procedure: 1. Patient to order and pay for the vaccine directly from the pharmacy 2. It is important for the nurse to provide education that the vaccine should be

transported and stored within recommended cold-chain temperatures. 3. All vaccines administered should be documented as outlined in section 3.4 of

the Nunavut Immunization Manual. As there may not be a specific protocol for every vaccine available for private purchase, the following resources can be utilized to guide the nurse in reviewing precautions, contraindications, recommended scheduling, and post-vaccine health education.

1. Canadian Immunization Guide (evergreen edition): https://www.canada.ca/en/public-health/services/canadian-immunization-guide.html

2. Vaccine package inserts 3. Specific vaccine product monographs can be found for all approved

drugs in Canada online at: https://health-products.canada.ca/dpd-bdpp/index-eng.jsp

Examples of non-publicly funded vaccines that nurses may be requested to administer include:

• Hepatitis A vaccine

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• Shingles vaccine • Meningococcal vaccine • Japanese Encephalitis vaccine • Typhoid • Rabies

Any additional questions about the administration of non-publicly funded vaccines can be directed to the regional CDC.

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Appendix A: Immunization Skills Checklist

Competency and Associated Skills

Self-assessment Supervisor or Delegate Aware Knowledgeable Proficient Reviewed

(initial) Plan of Action

Obtaining Informed Consent • Reviews benefits, common expected reactions, and

potential adverse reactions

• Proper documentation of informed consent Client assessment • Review immunization card • Client screening for contraindications Understanding and maintaining cold chain • Demonstrates understanding of vaccine fridge monitor

and vaccine transport.

Preparation of Vaccines • Correct vaccine preparation with aseptic

technique.

• Ensures anaphylaxis kit is up to date and available.

• Reviews steps for management of anaphylaxis.

Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill. Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill. Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

Review the following skills checklist. Immunization providers should complete at time of hire/onboarding and every 3 years (with exam). The original copy is filed in the immunization provider HR file and a copy is provided to the immunization provider.

The checklist should be reviewed with supervisor or delegate (including educators and peers who are at a proficient skill level).

The plan of action identifies what further steps the immunization provider should complete to further develop the skill(s).

A tentative date for the next review will be agreed upon and signed by both the immunization provider and supervisor.

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Competency and Associated Skills

Self-assessment Supervisor or Delegate Aware Knowledgeable Proficient Reviewed

(initial) Plan of Action

The 7 Rights of medication administration • Right patient • Right medication (vaccine) • Right dose • Right route • Right time (in accordance with NU schedule and

minimum spacing guidelines)

• Right documentation • Right reason Practical demonstration of the following skills using correct positioning/restraint techniques, landmarking, and correct needle size (once per skill).

• Intramuscular Injection - Infant • Intramuscular injection – child/adult • Subcutaneous injection • Intradermal injection Post-immunization Client education • Review vaccine after care guidelines • Plan/schedule the next immunization appointment Tuberculin Skin Testing (TST) • Understand the indications, contraindications and

when to defer TST

• Successfully demonstrate the administration and reading of TSTs.

• Ability to interpret TST results based on TB program standards

Immunization provider name (printed) and signature Date signed

Supervisor/delegate signature Date of next planned review

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